Some of the doctors are accused of trading drugs for sex, giving prescriptions to Facebook friends without proper medical exams and unnecessarily pulling teeth to justify writing pain pill prescriptions.

The list of indicted medical professionals includes podiatrists, orthopedic specialists, dentists, general practitioners and nurse practitioners.

Prosecutors said the specialties and methods varied among the accused, but the result in every case was the same: People addicted to pain medication received dangerous amounts of opioids, including oxycodone, methadone and morphine.

They said the illegal prescriptions put as many as 32 million pain pills in the hands of patients.

60 doctors, other prescribers face federal charges in biggest pain-pill bust in a five-state region including Ohio and Kentucky.

A special strike force from the Justice Department began making arrests early Wednesday, primarily in rural areas across Appalachia, which has been especially hard-hit by addiction to heroin and pain medication.

The names of many of the accused were not immediately available because they had not yet been arrested.

Most of the defendants face charges of unlawful distribution of controlled substances involving prescription opioids. Authorities say they gave out about 350,000 improper prescriptions in Alabama, Kentucky, Ohio, Tennessee and West Virginia.

Prosecutors described the doctors involved as drug dealers rather than medical professionals and said they were seeing a total of about 28,000 patients at the time of their arrests.

"If so-called medical professionals are going to behave like drug dealers, we're going to treat them like drug dealers," said Brian Benczkowski, an assistant attorney general at the Justice Department.

The defendants are accused of writing or filling prescriptions outside the course of medical practices and prescribing them despite having no legitimate medical reasons to do so, he said.

Strike force a first-of-its-kind effort

The Appalachian Regional Prescription Strike Force included more than 300 investigators from jurisdictions in all five states. Though targeting illegal prescriptions was a priority, federal officials say it wasn't the only goal.

In a first-of-its-kind effort, the federal criminal investigators are linking with public health to try to guide those who received the rogue prescriptions to addiction treatment, said Benjamin Glassman, the U.S. Attorney for the Southern District of Ohio.

Glassman said authorities recognize that closing clinics and arresting those who ran them won't solve the addiction problems of the patients who received the prescriptions. to help, he said, a public health official will be stationed at every clinic affected by the arrests.

The hope is "when these facilities are taken down, there are resources in place to give the best possible chance for those victims to get proper treatment," Glassman said.

"Opioids are the public health and safety crisis of our lifetime," he said. "This innovation, I hope, will be a road map for the future."

How the strike force worked the investigation

The strike force, which was created to attack the opioid epidemic late in 2018, worked a two-part investigation.

First, it used data analytics including prescription data monitoring programs from the states and Medicaid billing to identify potential offenders. Then it followed up with traditional, boots-on-the-ground law enforcement to zero in on suspects.

"We wanted to move quickly," Benczkowski said. The investigation went from January to Wednesday.

Federal prosecutors said illegal prescriptions are especially devastating to rural communities, where patients often have limited options when seeking medical help. If the doctor those patients see is peddling illegal prescriptions, prosecutors said, the damage to small towns can be dramatic.

The arrests Wednesday removed many doctors who "are simply white-coated drug dealers," said J. Douglas Overbey, U.S. attorney in the Eastern District of Tennessee.

Prosecutors said a physician in Dayton, Ohio, collected $5,000 a month in rent from a pharmacy located in his office, which provided pills after he signed prescriptions. They said another doctor in Alabama charged patients a "concierge fee" of $50 to $600 per visit.

Several doctors are accused of signing blank prescriptions and leaving them for their office staff to fill out when they were unavailable or out of town.

Unnecessary treatments, teeth pulled for pills

The arrests included a doctor in Kentucky who is accused of signing off on prescriptions via Facebook, without ever seeing the patients. Other doctors are accused of handing out pills directly for cash payments, including to pregnant women.

The defendant list includes 31 doctors, 22 other licensed medical professionals and seven others who are owners, operators or clinic employees, Benczkowski said.

Thousands of people would have received the illicit prescriptions. "It's enough pills for every man, woman and child to get one dose across the five states," he said.

Some people were given treatments they did not need in order to get the prescriptions filled. Benczkowski mentioned a dentist who is accused of unnecessarily pulling a patient's teeth.

The range of schemes included sending patients across state borders to see another general practitioner, writing prescriptions at different intervals rather than the originally prescribed number of days, and having patients fill prescriptions at different pharmacies.

The opioid epidemic has ravaged the Appalachian region. West Virginia was first, CDC data show, and Ohio was second in the nation for overall overdose deaths.

"Opioid misuse and abuse is an insidious epidemic," said John Martin, assistant administrator of the Drug Enforcement Administration. "Unfortunately, Appalachia is at the center of it."

Prescription opioid overdose deaths in Ohio dropped 28% since 2001 even as the synthetic fentanyl took over and overall overdose deaths kept rising. Yet prescription opioids remain critical, Glassman said. About 80% of people who use heroin first misused prescription opioids, according to National Institute on Drug Abuse statistics.

Doctors at two Hamilton, Ohio, medical clinics that prosecutors called “pill mills” were among those charged.

At one of the clinics, Cincinnati Centers for Pain Relief, officials said patients were often prescribed fentanyl, oxycodone, morphine and other highly addictive drugs without being seen by a doctor.

Across America, almost 218,000 people died from overdoses related to prescription opioids from 1999 to 2017, according to the Centers for Disease Control and Prevention. Overdose deaths involving prescription opioids were five times higher in 2017 than in 1999.